Category Archives: Pakistan

For the bourgeois and the patricians of Pakistan, their reaction to inflation is as different as is their lifestyle

“What has hit me and my family most is the price of milk and sugar going up in the last two years,” says Zainab Bibi who hails from Mailsi district in South of Punjab. She and her husband moved to Karachi a few years ago in search of a better standard of living. But for Zainab, an avid tea drinker whose staple diet continues to be chaai paratha, it is not easy surviving in Karachi as items that make up her sticky sweet tea are pricier than in her village. “One reason I came here is that I want to save enough to build two rooms in my village, my own home. But the price per 1000 red bricks has risen from Rs5000 to Rs8000 within two years.”

In contrast to Zainab’s economic challenges, the challenge of Samiya Khan (name changed), a resident of the uptown Defence area in Karachi is different. “You are asking the wrong person. I honestly have not felt the pinch as my husband just gives me his card; I go to the supermarket and swipe it to pay without even checking the prices minutely. But if at all, I would say the prices of imported food items have gone up. The chocolate spread my children love eating and I use for baking cupcakes has gone up from Rs280 to Rs450. However, I don’t think prices have gone up that much. Have they?” she says.

Prices of consumer goods, utilities and luxury items going up is never taken lightly. But which prices affect which strata of society is the key to understanding how closely linked income inequality and inflation are.

Pakistan’s annual inflation rate rose to 7.2 percent in January of 2019 from 6.17 percent in the previous month. It was the highest inflation rate since September of 2014, as shared by Trading Economics. According to the State Bank of Pakistan’s website, Headline CPI (Consumer Price Index) inflation (2007-08=100) was recorded at a level of 6.2 percent on year-on-year basis in December 2018 as compared to 4.6 percent during corresponding month of last year.

According to data shared by Pakistan Bureau of Statistics (PBS), January 2019 saw an increase in prices of items like sugar, fresh fruits, pulses and tomatoes, but also saw a decrease in the prices of chicken (by 18.06 percent), eggs, onions and potatoes.

But for Zainab Bibi, all this does not translate into a major change, and the one underlying take home message she has in her mind is simple — A good life in Naya Pakistan is as unaffordable as purana Pakistan, even though fuel prices have gone down although electricity prices have gone up if compared between December 2018 and January 2019.

For the bourgeois and the patricians of Pakistan, their reaction to inflation is as different as is their lifestyle when compared to the struggling lower middle class or the yet lower strata on the economic ladder. When asked which household needs had taken a dent due to inflation in Pakistan, the elite is often found themselves confused between needs and wants, and often complain of how luxury spending has been affected.

It is not that the well-off people do not get impacted by inflation. The price of fuel affects the prices of water tankers for the upper tier. When this happens, their lush lawns become parched, they stop washing their car porches frequently.

Over lavish high-teas, the conversations often include how the price of air travel has gone up, and vacations are becoming pricier. Delve deeper and the falling rate of the Pak rupee has affected how they will pay the fee of their children studying abroad in dollars and pounds. “I am very happy actually; my children’s school fee has been considerably reduced since the new government came in,” says a young mother whose two children are students at an upper tier school in Karachi.

What varies is the pinch someone feels when prices go up, depending on affordability. The theory of relativity may then not be applicable only to laws of physics, neutrons and black holes. How every Pakistani experiences inflation is in relation with how much they can afford, their spending habits, and their bank statement, if they have a bank account, that is.

Yet one strata feeling the hit of inflation does spill over to the other strata as well. When a darzi (tailor) increases the rate of a female shalwar kameez, the pinch is felt by all, but few join the dots that the cost of commute of the tailor and his assistants has gone up because petrol is pricey. The ticket for a bus traveller, the fare for a rikshaw commuter, or the cost of fuel for someone who goes on a motorbike — all go up. Consequently, so do the prices of general household items.

It is not that the well-off people do not get impacted by inflation. The price of fuel affects the prices of water tankers for the upper tier. When this happens, their lush lawns become comparatively parched, they stop washing their car porches frequently, and they opt for ‘made in Pakistan’ semi-automatic washing machines to save water. If fuel is pricier, one thinks twice before opting for the generator during long sultry hours of load shedding, and opts for the UPS. And if electricity rates climb up, the use of air conditioners has to be well thought-out. Last if not the least, climbing rates of gas means affluent Pakistanis are actually considering opting for smaller water-heater geysers that can be easily put on and off as and when needed.

But for those who have to start worrying about the prices of potatoes and ghee, and have far too many mouths to feed but way too less earning hands, inflation is a bad word. It is time those on top of the food chain let some resources trickle down to make life easier for all. We may not be able to reduce inflation, but maybe we can somewhat reduce the widening economic inequality.

Costed Implementation Plan is a right step forward in improving the state of family planning in Sindh

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As Pakistan’s second most populous province, with the population projected to increase to 61.7 million by the year 2030, Sindh has a lot to achieve. Out of a conservatively estimated population of 46 million, as per the Sindh Population Policy (SPP) 2016, a majority of which resides in urban areas, the actual population has the province bursting at the seams, with massive numbers of people migrating to Sindh, particularly the mega city Karachi.

The indexes are not encouraging. Sindh fares lower than the blue-eyed and better governed Punjab when indicators of both provinces are juxtaposed. The developmentally nascent Khyber-Pakhtunkhwa is also showing more promising upward trends.

Sindh has had successes, but numbered and calculated. While the Total Fertility Rate (TFR) declined from 5.1 births (in 1990-91) to 3.9 births (in 2012-13) in Sindh, the contraceptive prevalence rate (CPR) for Sindh seems to be stuck in a status quo at 29.5 per cent during 2001-2013. Though 96 per cent of the population is aware of at least one method of family planning, the unmet need for contraception in Sindh is still stuck at 21 per cent. In 2015, 13 million women were of reproductive age (ages 15–49), a number expected to rise to 15 million by 2020.

The SPP 2016 shares its high hopes and important but farfetched aims. One of them is to ensure contraceptive commodity security up to 80 per cent at all public service outlets by 2018, while another aims to increase access to Family Planning (FP) and reproductive health services to the most remote and farthest areas of the province by 2017. With almost three quarters of 2017 having passed, this is a good point in time to take a look at the state of family planning in Sindh.

At such a time, the Costed implementation Plan (CIP) promises a glimmer of hope — hope that is conditional to implementation. As a five-year actionable roadmap designed to help the Sindh government achieve its FP goals, the Sindh CIP can play a critical tool in achieving targets. Sindh is Pakistan’s first province to develop a CIP on family planning. The motivation, perhaps, is not just the challenges a large population puts in front of Sindh’s developmental efforts. The political will of late prime minister Benazir Bhutto still looms large as an influence over Sindh’s policy makers. “I dream of a Pakistan, of an Asia, of a World, where every pregnancy is planned and every child conceived is nurtured, loved, educated, and supported,” she once said.

Looking at data from Sindh, it is clear that one of the most important factors is increasing the awareness among the population. A case in point is that the two most frequently used FP methods in Sindh are female sterilisation and condoms.

The government of Sindh allocated PKR 890 million (US$8.5 million) during the last fiscal year (July 2015–June 2016) to CIP activities for 2015–2019. If the CIP, the cost of which is an estimated PKR 79.12 billion (US$ 781 million), does get implemented, the positive ramifications can be immense. It can have an impact not just on the FP efforts, but will also impact health, education, women’s empowerment, employment, as well as demographic and economic activities. Experts predict that if the proposed interventions are carried out, 1,848 maternal deaths and 29,470 child deaths could be averted by the year 2020. Some 1,774,367 unintended pregnancies and 193,332 unsafe abortions could be averted.

This is sorely needed. Earlier this year, Dr Talib Lashari, Technical Advisor, Costed Implementation Programme of Sindh Population Welfare Department, shared with members of the media that Sindh’s birth rate is 1,240,467 per year. This high birth rate, he commented, would not only result in poverty, but also in an insufficiency of resources available to the people of the province.

The estimated cost of the Sindh CIP includes an infrastructure upgrade and mass media campaign. These two aims will help increase awareness among not just the masses but also help sensitise on-ground staff, medical personnel and government officials towards FP. The hope, then, is to eventually reach a point that results in a change of the mindset and not just the numbers.

One of the key tools in the practical implementation of the CIP are the lady health workers (LHWs) who can play an effective role. LHWs carry out layered and multiple roles, and work on activities related to community awareness, maternal health, nutrition, immunisation, FP, as well as providing guidance on minor ailments and health education. They have access into the homes of their communities, and have social impact.

A weak infrastructure and social attitudes make mobility of women to the distant and numbered public health units difficult. LHWs fulfill the need to go door-to-door and convince the communities regarding FP. Pakistan’s FP 2020 commitment requires that the role of the LHWs in FP be enhanced. It is encouraging that the CIP team recently concluded that 50 per cent of allocations for the LHW Programme would be dedicated for family planning work, rather than the earlier 25 per cent.

Other important parts of this jigsaw puzzle that cannot be afforded to be missed are the Lady Health Visitor (LHVs), Community Midwives, Rural Health Centres (RHCs) and Basic Health Units (BHUs). There are some 22,575 LHWs and 770 Lady Health Supervisors (LHS) working in Sindh.

An exhaustive consultative process with stakeholders enabled the PWD and Department of Health (DOH) in identifying six strategic areas for investment in FP, all equally important. They are well planned out and focus on both increasing knowledge and awareness among the communities as well as better governance, improved coordination among the government departments working on it, and consistent government spending on this cause.

Looking at data from Sindh, it is clear that one of the most important factors is increasing the awareness among the population. A case in point is that the two most frequently used FP methods in Sindh are female sterilisation and condoms. While people are aware of short-term methods like condoms, pills and injections, the use of these methods remains low, and will remain low till the people are made aware and the contraceptives are made readily available. There are vast disparities in the provinces urban and rural development landscapes. The CPR rate in urban areas is of 42.7 per cent, compared to 17.4 per cent in rural areas.

If this province has any hope of attaining success with regards to the Sustainable Development Goals (SDGs) 2030, FP will have to be a key focus. It is hoped that the CIP fulfills its aims, and alongside effective FP, also positively impacts literacy and education in Sindh, as well women’s empowerment via increased work participation and economic self-sufficiency.

The 8th Karachi Literary Festival saw an increased footfall and as ever became the most happening event in the city by the sea

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Over three days, everyone who is anyone flocked to the Karachi Literature Festival (KLF) 2017. Crisp starched saris, Kolhapuri chappals, white hair and white chooridars, pure leather-bound notebooks, endless rounds of tea serving as the fuel for animated conversations about existentialism, philosophy, politics, the arts, and the role literature plays for all of these. The 8th KLF saw an increased footfall and as ever became the most happening event in the city by the sea.

“The KLF has busted many myths that existed about Karachi and its people. This festival has now successfully added ‘literary tradition’ to the list of things Karachi is known for. The literary tradition that is the legacy of our elders has been rekindled in our youth and we at the Oxford University Press (OUP) Pakistan are extremely proud to be the flag bearers of literary festivals in Pakistan,” says Saadia Mirza, Rights Manager at OUP.

The KLF was launched in March 2010, and is directed by Ameena Saiyid, founded by Ameena Saiyid and Asif Farrukhi, and produced by OUP. It is open to all and the entry is free. It features debates, discussions, talks, English poetry readings and Urdu mushaira, a book fair, book launches, readings, signings, satire, theatre, film screenings, music, and dance.

KLF has grown — from an attendance of roughly 5,000 in 2010 to 175,000 in 2016. In 2010 it had 34 sessions with 58 speakers/performers. This year, the 8th KLF featured close to 200 speakers and performers in around 76 sessions.

This year, a recurrent theme that surfaced in many talks was Pakistan’s economic challenges, and how they are affecting society and culture as a whole.

The important issue of gender was brought up in many a panel. Feminist activists and writers like Fahmida Riaz, Sheema Kirmani, Zehra Nigah and Sania Saeed were seen prominently participating. One unique book that was launched was Interpreting Islam, Modernity and Women’s Rights in Pakistan by Dr Anita Weiss, Professor at the University of Oregon. It was her second time at the KLF.

KLF has grown — from an attendance of roughly 5,000 in 2010 to 175,000 in 2016. In 2010 it had 34 sessions with 58 speakers/performers. This year, the 8th KLF featured close to 200 speakers and performers in around 76 sessions.

“The first time was in 2012. I’ve seen a few important changes. First, there is a lot more emphasis on books now. Previously there were a lot of talks, but not necessarily connected to explicit things people had written. Second, the audience now seems even more diverse than in 2012, with people coming from all walks of life,” says Dr Weiss.

However, the diversity she sees as positive is seen by some as a recession in the exclusivity of the KLF. The elite ownership and intellectual regality seems to be diluting. Some see this as a positive; others don’t. Many visitors were overheard commenting that the standard of the KLF is going down, referring to the fact that it is becoming more awaami which is resulting in a deconstruction of some of the carefully constructed social silos.

However, people like journalist and documentary filmmaker Faisal Sayani feel the opposite to be true. “The selection process seems flawed and nepotism-based, and KLF has become commercialised. But the festival is not, in essence, designed in a way that would deprive or bar masses from it. I find it to be pretty inclusive,” says Sayani.

He praised how many sessions dealt with important aspects of history, and praised in particular the session of screening of the documentary of slain activist Parween Rehman. But not everyone, according to him, visits the KLF for the love of the written word. “I believe hoards of people are just there socialise and take selfies with intellectual celebs.”

In a city like Karachi, a diverse crowd is but natural. “Karachi is a melting pot of so many ethnic and linguistic traditions that it is not easy to define the culture and tradition of this city — the Karachi experience is an intense experience. And that intensity is reflected in the sessions of the KLF. Any visitors will vouch for the palpable energy in the atmosphere of the KLF as writers, readers, politicians, actors, musicians, students, poets, academics and journalists all come together to celebrate the literary achievements and discuss the issues faced by Pakistan today,” says Mirza.

One of the most important sessions was about the city, titled “‘Karachi: Is Pakistan’s Boom Town still Booming?”, with a panel of people who know Karachi, especially the unparalleled Arif Hasan who knows the city better than anyone else.

“In 2015, 902 cars were registered daily in Karachi; during the last six months 800 motorbikes were registered daily. This city cannot accommodate it,” says Hasan. He raised brave questions about where the money being invested into Karachi’s real estate is coming from. Answering a question, he said that the main issue with Karachi is the tension that exists because it is the capital of a Sindhi-speaking province being dominated by a non-Sindhi speaking minority of the province.

The panel included stalwarts of Karachi, namely Aquila Ismail who is writer, activist and sister of Parween Rehman, Najmuddin Shaikh who is a distinguished diplomat, and Haris Gazdar who is a renowned researcher. Ismail compared Karachi to the mythical city of El Dorado, and said the gold of this city is in the hearts of its residents.

The crowd-pullers in the open air garden were more than just literary. One such popular celebrity session was the former celluloid queen Shabnam in conversation with Bushra Ansari. Shabnam brought back memories of a Pakistan before the fall of Dacca, and spoke about the best of times and the worst of times. Stand-up comedian Shafaat Ali provided the comic relief at the same venue, while the legendary Zia Mohyeddin’s reading session titled “Memories and Reflections” gave the KLF what completed it.

While many visitors observed that the number of sessions in Urdu and especially vernacular languages has decreased, Dr Weiss says that the writers were very diverse. But she adds that “There should be an effort to have greater regional distribution of authors, such as some coming from Khyber Pakhtunkhwa or from Balochistan. There are important works coming out of those provinces, and effort should be made to include them.”

When asked why KLF and such festivals are important, Dr Weiss summed it up. “This is a celebration of the life of the mind.”

True to the KLF tradition, five literary prizes were awarded this year too at the festival.

The recently held Karachi Literature Festival 2017 was a hub alright. But a hub of what? What it stands for, ideally, is not just celebrating books and authors, but also to serve as a hub for Pakistan’s beautiful minds that allow critical thinking and are truly progressive. Literature and the arts, on such forums, are designed to allow an open inflow and outflow of thoughts and ideas, and an exchange of not just narrative but also counter narrative.

One counterfoil session of the KLF 2017 was introduced as a discussion on conflict-resolution through art and enterprise. One of Pakistan’s well known musicians dared to play a short video as a tribute to the late Pakistani pop icon-turned-evangelist Junaid Jamshed, and went on to talk about how he and Junaid, despite ideological differences, managed to remain lifelong friends, and worked in collaboration on projects pertaining to peace-building. The reaction of a renowned “liberal and progressive” scholar on the panel was perhaps not unexpected but certainly unwarranted. He ridiculed Junaid Jamshed’s long beard and dressing style, and then went on to comment on his alleged misogyny. The comments were not just out of context. They were a giveaway of something that we don’t talk about often enough, which is that when it comes to “liberalism”, Pakistanis seem to have lost the plot.

Most dictionaries define a “liberal” in words as these: Someone who is open to new behaviour or opinions and willing to discard traditional values; lacking moral restraint; tolerant to change; a moderate person or viewpoint that favours a society or social code less restrictive than the current one, and welcomes constructive change in approaches to solving economic, social, and other problems.

The irony of ironies is that the very things liberalism stands against – being judgmental, being inflexible and being rigid – are the very traps we see liberals falling into. Liberal thought is, in essence, the anti-thesis of extremism and fundamentalism. It is the willingness to burst bubbles, push boundaries, and think out of boxes. True liberalism is having the heart to listen open-mindedly to an opposing view point, even though you may disagree vehemently.

Pakistan, today, is in desperate need of truly liberal people who may have their own set of beliefs, yet are willing to hear the other side out, and engage in dialogue. The intelligentsia, as it consists of more evolved people, has on it the responsibility of building bridges. Instead, what we are seeing on both sides is deep intolerance. The religious are seen indulging in feel-good extremism, and write off those who don’t follow religion in exactly the way they interpret it. For that, they get the flack which is perhaps justified. But it is less painful because the right-wingers never really claim to be open-minded. It hits worse when those who claim to be progressive and liberal follow the same patterns. Ironically, many of them, if not all, end up being equally intolerant of dissenting viewpoints, if not more.

Puritanical thinking makes one feel holier-than-thou (and this holds true for both the left and the right, for both the religious and the secular), plugs our ears to voices of those we see as “the others”, and perpetuates a binary world view, leading to the “it is either my way or the high way” attitude.

For cases in point, one should skim through social media websites. The easiest and laziest thing to do is put blanket generalisations on groups of people – something we are becoming very good at. Common assumptions are that a bearded man or a hijabi woman cannot be a human rights activist, a peace-builder or one raising their voice against domestic violence. Equally common are counterpart assumptions that a woman donning a sleeveless shirt or a man who is in the music or showbiz industry lack in faith.

Sneering at the opposite camps might get one some additional readers and followers, or a few guffaws from a chisel-headed audience that wants to enjoy the comfort of collaborative mockery. But what many of our brightest minds end up looking like is eternal teenagers and wandering Peter Pans who imagine the world as a virtual university town where everyone must conform to thinking in a certain way.

This is not to undermine the contributions KLF and similar forums are making. It is just that by default, events that act as magnets to the urban elite seem less welcoming to those who differ socially or ideologically.

We are all living in our ideological silos, comfortable in our respective bubbles with our own sets of designated cheerleaders. No one wants to try understanding another point of view. We sing praises of a word called “empathy” when we have not even arrived at the station of “tolerance”. We spare neither the living, nor the dead. And through it all, we see ourselves as the problem-solvers when we, ourselves, are part of the problem of polarisation. How, then, can any of us claim to be liberal?

If Pakistan truly wants to get rid of extremism, there will have to be more open-minded listening, especially listening to those who are not on the same page as you, without jesting about or being dismissive of the other point of view.

Farahnaz is a writer and editor, and has worked as the Features Editor with The Express Tribune. Her focus is human-centric feature stories. She now writes as a freelancer, and works in the field of corporate communications. She loves literature and traveling. She tweets @FarahnazZahidi. Her work can be seen at chaaidaani.wordpress.com/

Being a man isn’t just about masculinity

It is generally seen as okay for a man to speak loudly or even yell or curse. Even in the most seemingly progressive families, girls are often told not to talk or laugh loudly. PHOTO: RANGIZZZ/SHUTTERSTOCK

“But that’s how we guys are.”

Is a common response when a woman asks a man about a few traits and attitudes that are seen asmanly and macho.

While walking on a street near you, in a mall, or even when couples enter weddings – a familiar scenario ensues. The husband can be seen walking a few steps ahead of the wife for sure, and the wife trudging behind him, adjusting her ensemble, trying to catch up.

In our society, or maybe that is how it is all over the world, a few things are seen as ‘guy things.’

For example, the obscene joke sharing. It seems that there is an unsaid rule that in order to classify as a man, you absolutely must share lame and cheap jokes, and video clips and photographs of women in awkward or objectionable poses. Whatever one shares amongst friends is the personal business of each individual. But what is worrisome is how this is seen as a sign of masculinity. Such stereotypes are so etched in our social fabric that we are conditioned to think this is what makes a guy a ‘man.’

Ever seen prime time dramas on Pakistani television channels? They all seem to imply that it is some signature symptom of manliness for men to have affairs, cheat on the wife, and have physical needs, while a good, demure woman is stereotyped as a prudish character who is always shy and playing hard to get.

It is generally seen as okay for a man to speak loudly or even yell or curse. Even in the most seemingly progressive families, girls are often told not to talk or laugh loudly.

It is the men who are supposed to drive the car even if the wife or sister is the better driver or even if the poor husband or brother is exhausted after a long day at work. It is encouraging, actually, when one meets a man who is man enough to say “I don’t enjoy driving” if he doesn’t. But mostly they are unable to voice it, just like it is not easy for a woman to say she does not enjoy cooking.

Women themselves are participants in the act of perpetuating these stereotypes.

They feel sympathy for their sons or brothers if they help the wife with carrying the baby,change the baby’s diapers, or God forbids take paternal leave. Helping in the kitchen is something real men, of course, don’t do.

This conventionalising is not always in favour of men, and is not always healthy. Consider the economic arena.

In this age of inflation and consumerism, one salary is often not enough to support a family. With more and more women joining the work force in Pakistan, both can spend on the collective household. But gender stereotyping ends up pushing both males and females in pigeonholes of rigidly defined roles. The man ends up not helping the woman in the kitchen and housework even if she is also an earning member of the family. Similarly, even if he does end up lending a hand at home, many working women confess to feeling a pinch inside when they have to spend on their families. The feeling is best described as being made to do something they are not supposed to be doing.

Man-kind has not really progressed that much, has it, when the marks of manliness are not values like strength, courage and honesty, but instead driving a sports car, riding a massive motorbike in boots, or smoking a cigarette in public.

There are some inherent traits and tilts that are natural to both the genders. Some of these are natural. But others are not. They are just by-products of being exposed to certain socio-cultural habits of a nation.

For those who are the strongest of men, it wouldn’t be a bad idea to push their boundaries and challenge these norms by walking behind the wife or speaking softly and let the woman in your life have the last word. Being a man takes more than that.

Farahnaz is a writer and editor, and has worked as the Features Editor with The Express Tribune. Her focus is human-centric feature stories. She now writes as a freelancer, and works in the field of marketing and corporate communications. She loves literature and traveling. Her work can be seen at chaaidaani.wordpress.com/

As people age, what can we do to improve their quality of life?
“With the bam of a motorcycle I suddenly became the head of the family,” says Junaid Ahmed Qazi. While caring for the elderly is seen primarily as something that women are expected do, Qazi is defying the norms because life left him no choice. As an only child, life changed for him some 20 months ago when his father, a healthy man in his early 70s, became victim of a hit-and-run case.
“Ten days before the accident we had both climbed five flights of stairs together.” What followed was a brain surgery, weeks in the ICU, and a nosocomial (hospital-acquired) infection his father caught, that left him invalid. “We believe he recognises us and has emotions. He wants to talk but cannot,” says Qazi.
For him the sound of his father’s voice is a far-fetched dream. Yet the optimist in him refuses to give up.
Qazi’s troubles are not unusual. The number of elderly people has risen globally with life expectancy having gone up due to advanced medical interventions. So has the corresponding number of their caregivers. The average life expectancy at birth of the global population in 2015 has risen to 71.4 years according to the WHO’s Global Health Observatory (GHO). HelpAge, a global network of organisations working with and for older people, predicts that by 2050 one in five South Asians will be over 60. The network states that South Asia is growing older faster than any other country in the world.
While HelpAge’s Global AgeWatch Index 2015, that ranks countries by how well their older populations are faring, rates Pakistan at 92 out of 96 countries, healthcare professionals and doctors feel the close-knit family structure in Pakistan mitigates cases of neglect and abandonment of the elderly.
“Caregivers are the unsung heroes when it comes to geriatric care. They are also underappreciated. When Parkinson’s disease or Alzheimer’s strikes a patient, the entire family is affected,” says Dr Nadir Ali Syed, a neurologist at Karachi’s South City Hospital who has been treating elderly people for 25 years. In his experience, if the quality of life of old people in countries like the US and Pakistan is compared, the elderly in Pakistan are much better off, provided their families are taking care of them. “The family is vital for elderly people. Generally, our elderly are not subject to neglect.”
With an increase in urbanisation and more Pakistani women joining the workforce, old homes and healthcare centres for the elderly is a discussion that is expected to come up more and more in the years to come. The need for geriatric medical care and for doctors specialising in the field has also gone up, and related challenges are multilayered.
“There is a lack of awareness and an acknowledgement of geriatrics as a unique specialty with special needs, health issues and care requirements. This exists both at the level of physicians, and at the governmental level. Caregivers often do not understand the needs of their aged family members and the stresses involved in caring for the elderly,” says Dr Saniya Sabzwari who specialises in geriatric care at the Aga Khan University Hospital in Karachi.
“Caregivers are the unsung heroes when it comes to geriatric care. They are also underappreciated. When Parkinson’s disease or Alzheimer’s strikes a patient, the entire family is affected,” says Dr Nadir Ali Syed, a neurologist at Karachi’s South City Hospital who has been treating elderly people for 25 years.
The patience and endurance of caregivers are put to the test in more than one way and, practically, providing satisfactory healthcare to the elderly is an expensive proposition. “The biggest challenge is financial. Nursing care and attendants at home cost a lot. For those who cannot afford to hire professional healthcare at home, the challenge is even more daunting. It becomes physically difficult to look after an invalid person,” says Asma Nazeer, who requested that her real name not be shared.
Nazeer does not want people to know that she served her mother who had Parkinson’s and related dementia for 10 years, since she feels that it will take away from her award. “I was the only one, as all my siblings are abroad, so they sent help in the form of finances and sporadic visits but basically it was just me for 10 years.”
Nursing care at home for the elderly who suffer from a lack of mobility is expensive. Yet more and more people are opting for it. “The biggest determinant for better geriatric care is affordability — to be able to pay for quality healthcare,” affirms Dr Syed.
Two round-the-clock certified nurses take care of Qazi’s father who, he shares, are pampered by him so that he does not have to go through the process of changing nurses and teaching them the ropes repeatedly. The price of nursing care at home is exorbitant but it still costs him less than the hospital would. His father’s room is now nothing less than the Intensive Care Unit of any hospital emanating the smell of medicines and sterilising liquids. Oxygen cylinders and the feeding tube through which liquefied food is transferred to his father’s stomach, like most elderly patients who are no longer able to eat by mouth due to multiple reasons, are maintained by nurses.
On average, depending on the level of expertise and seriousness of the patient’s illness, a certified nurse for a 12-hour shift costs anywhere between Rs1,200 to 1,800 or more, and are hired through an agency. The monthly cost can run into more than Rs100,000 if two staff nurses and two attendants are hired. “Many nurses are now turning towards attending to bedridden elderly patients at home because it pays well,” says 24-years-old Zaiba Kiran, a staff nurse who has been caring for elderly patients who are mostly bedridden. “We go through agents because it suits both the family of the patient and the nurse in case the nurse needs a day off or either of the parties has any complaints.”
Just like it is tough for caregivers, caring for debilitated elderly patients is not easy for nurses either. “With an elderly patient we have to be extra careful. They are very fragile. They can choke easily. We have to keep a constant watch over their vitals. Anything can happen at any time. It also takes more energy and time to learn how to deal with an elderly patient; they are often impatient like children.”
But perhaps the biggest side effect of seeing your loved parent become a shadow of who they used to be is psychological. “We saw the stages where my mother would hallucinate and there were behavioural changes. But the most painful was the stage when she could not even lift her finger. For the last three years of her life she was fed through a nasal tube,” reminisces Nazeer.
One of the jolts a family may receive is when they are told their loved one is now on what is called palliative or end-of-life care, a concept that is often not fully understood. The term does not mean that these are the final hours or days of the patient’s life. It means that the patient suffers from a terminal disease, and there is no hope of a cure. However the dying process may take years.
“With patients of Alzheimer’s the process may take seven to 12 years,” says Dr Syed. The aim of doctors and family, at this stage, is that the quality of life be improved and the patient be made comfortable. “In Pakistan you get drugs like heroine everywhere but intravenous morphine is not available to a dying patient to help relieve a dying patient’s suffering,” says Dr Syed, explaining the obstacles.
The goal, as Dr Sabzwari explains, is not longevity of life, unlike what families or patients want. “Most important is the quality of life.”
To see a loved one in pain takes its toll. “Till my father had the accident, I was a carefree guy. I can safely say I aged at least 10 years within days. I have lost a lot of hair ever since. I do feel depressed inside at times but I cannot afford the luxury to sit and cry because the responsibility of my family is on me,” says Qazi.
Luckily for him, his supportive wife has been his biggest strength. Even families of the elderly are psychologically impacted. “My six-year-old daughter is affected as well; she can’t understand why dada won’t play with her anymore.” Yet, Qazi refuses to give up on giving the best possible care to his father. “My father didn’t stop caring for me when I was a child and was totally dependent on him. How can I stop taking care of him?”
In Dr Syed’s opinion, one must not give up on the treatment and care of the elderly because a lot can be done to improve their quality of life. “A few years ago dementia was considered incurable and some of the treatments available now were not available then. Now, we can drastically improve the patient’s quality of life as well as slow down the dementia.”
The biggest challenge, then, is to not give up hope.

A Pakistani vendor arranges morning newspapers with front-page-coverage of the attack by gunmen on French satirical weekly Charlie Hebdo in Paris, at a roadside newsstand in Islamabad. PHOTO: AFP

You know, therefore you are.

And we know because of the press. Be it print or broadcast, media is what keeps you updated. It provides us with information because it is our right to know, and it is the press’ right to relay that information.

The press, or a more relevant term today might be the media (that includes products of both print as well as broadcast and digital journalism) relay that information to you.

But, if you are a Pakistani and have never been a part of the media, never seen the workings of a newsroom and have never been a reporter, it is a given that you are someone who has hurled abuses, chanted frustrated expletives and blamed the media and press for everything that has gone wrong in the world.

The headlines can be scandalous and out of context. The reporters and TV anchors cross lines. Media ethics are ripped apart every time a tragedy takes place, where cameras are thrust in the faces of victims and survivors. Information is relayed first and thought about later.

While print media (newspapers), exercises much more care and caution compared to TV, the web wing of newspapers is another animal altogether. News has to be broken within minutes otherwise it becomes redundant and stale. “It’s already been covered” is the worst nightmare in the web room. To make their story novel and different, value additions are pushed through and the ‘treatment’ of the story is altered to get more hits.

Journalists are paid a pittance, especially if they are in print media, and those that write in a local language are paid even less. The one thrill that keeps them going is the sheer joy of being able to tell a story or create awareness while taking the credit for it; their name or face appearing with the news story. And for this, they risk their lives.

With every passing day, our viewers, readers and listeners are also becoming less forgiving. A decade ago, we could have gotten away with shoddy and loud journalism by saying,

The initial euphoria of freedom after an era of being the proverbial “press in chains” has now begun to die down. Which means the media will not be able to get away with anything and everything. Also, mistakes made by the media, like everyone else, can become a social media trend within minutes. Whether the media person was right or wrong, how they should be dealt with is another debate.

But if media persons ask politician’s scandalous questions, storm into assemblies, do moral policing of dating couples in parks, or show unreasonable tilts towards an ideology or person, they cannot go scot-free. Writers and reporters should not be allowed to base entire stories on hypothetical sources and should not be allowed to share data without citations. Today’s media is grilled and criticised. If nothing else, the social media trial will take them to task.

And it must.

The absence of a check and balance corrupts anyone in a position of power, and one of the most powerful positions to be in is as a media person. What we say, show or write reaches millions. We, the media, are answerable.

Yet, as the world today celebrates the 250th Press Freedom Day, is Pakistani media really free?

What we know as ‘policy matters’ and ‘security concerns’ often hold back the pen or the microphone of the reporter to relay information that must reach the public. Certain ideas are shot down by editors due to fear of backlash and ruffling too many feathers, and then we wonder why our best journalists end up writing for foreign publications and not local ones.

Fears of consequences, tilts and allegiances of patrons, the editor’s discretionary powers to chop or discard a good pitch or story and the simple fear of becoming unpopular or redundant, often hold a journalist back from the noble task of telling the truth, and nothing but the truth.

In a world where surveillance of citizens is legally accepted, why should a media person’s right to ask questions be curtailed?

While absolutism in freedom of speech can be harmful, strict censorships harm a society by not only restricting, but mutating the development of healthy collective thought processes.

The annual report of press freedom by media watchdog Reporters Without Borders (RSF) stated that Pakistan has been ranked 159 out of 180 countries. Yet, these restrictions are not just limited to Pakistan as the world at large is failing on many counts when it comes to providing press the required freedom.

In an era plagued with conflict, fear of life is what causes us, the media persons, to bite our tongues and throw away our pens.

The need of the day is to educate our press and media persons regarding media ethics, but at the same time, their safety should be safeguarded while ensuring that they can speak up without fear of losing their audience, their jobs or their lives.